Adolescent mental well-being, religion and family activities: a cross-sectional study (Northern Ireland Schools and Wellbeing Study).

OBJECTIVES: In this study, we seek to explore the relationship between adolescent mental well-being, religion and family activities among a school-based adolescent sample from Northern Ireland. SETTING: The Northern Ireland Schools and Wellbeing Study is a cross-sectional study (2014-2016) of pupils in Northern Ireland aged 13-18 years. PARTICIPANTS: 1618 adolescents from eight schools participated in this study. OUTCOMES MEASURES: Our primary outcome measure was derived using the Warwick-Edinburgh Mental Wellbeing Scale. We used hierarchical linear regression to explore the independent effects of a range of personal/social factors, including religious affiliation, importance of religion and family activities. RESULTS: In fully adjusted models, older adolescents and females reported lower mental well-being scores-for the year-on-year increase in age ß=-0.45 (95% CI=-0.84, -0.06), and for females (compared with males) ß=-5.25 (95% CI=-6.16, -4.33). More affluent adolescents reported better mental well-being. No significant differences in mental well-being scores across religious groups was found: compared with Catholics, Protestant adolescents recorded ß=-0.83 (95% CI=-2.17, 0.51), other religious groups ß=-2.44 (95% CI=-5.49, 0.62) and atheist adolescents ß=-1.01 (95% CI=-2.60, 0.58). The importance of religion in the adolescents' lives was also tested: (compared with those for whom it was not important) those for whom it was very important had better mental well-being (ß=1.63: 95% CI=0.32, 2.95). Higher levels of family activities were associated with higher mental well-being: each unit increase in family activity produced a 1.45% increase in the mental well-being score (ß=0.78: 95% CI=0.67, 0.90). CONCLUSIONS: This study indicates that non-religious adolescents may have lower mental well-being scores when compared with their more religious peers, irrespective of religious denomination. This may relate to both a sense of lack of firm identity and perceived marginalisation. Additionally, adolescents with poor family cohesion are more vulnerable to poor mental well-being.

Occupation type, family demands and mental health: analysis of linked administrative data.

BACKGROUND: While employment generally promotes positive health and wellbeing, some jobs may be less salutogenic than others. Few studies have examined mental health across a range of broadly defined occupation types using a large population sample. AIMS: To examine the prevalence of mental health problems across a wide range of occupation types, and further examine the association of family demands, controlling for key social determinants and health-related factors. METHODS: We used linked administrative data from 2011 NI Census returns; NI Properties data; and Enhanced Prescribing Data (EPD) 2011/12. We examined self-reported mental health problems and receipt of psychotropic medication among 553,925 workers aged 25 and 59 years. RESULTS: Self-reported chronic mental ill health was more prevalent among workers in lower paid occupations, while "public- facing" occupations had the highest rates of medication. In fully adjusted models, informal caregivers were less likely to report mental health problems but more likely to be in receipt of psychotropic medication, as were lone parents. The association of family demands also varied across occupational groupings. CONCLUSION: Future development of mental health at work plans should take cognisance of occupation specific mental health risk and wider family circumstances to support workers' mental wellbeing most effectively.

Assessment of pain in people living with dementia at the end of life: a systematic review.

BACKGROUND: People with dementia may not receive the same quality of palliative care as those with other life-limiting conditions, particularly at end of life (EoL). AIMS: To understand the best way to examine pain in people with dementia. METHODS: A systematic review of tools to assess pain in patients with dementia near the end of life; PubMed, Medline, Embase, EBSCO Host, CINAHL Plus, Web of Science, Psycinfo, PsycArticles and Scopus were searched. FINDINGS: A total of 15 articles were identified, which were qualitatively synthesised. CONCLUSION: There are a range of pain assessment tools that are appropriate for use in people with dementia, but all 15 studies used a formal tool. A more robust approach is needed to improve the quality of research for measurement and management of pain in this population.

Social variations in uptake of disability benefits: A census-based record linkage study.

BACKGROUND: Significant variation in disability-related social security benefits receipt might highlight sub-populations and groups with unmet needs and also have implications for areal indicators of disadvantage that are largely derived from uptake of benefits. In this paper we examine Disability Living Allowance (DLA), a non means-tested contribution towards disability-related living costs for disabled people aged less than sixty-five. METHOD: ology: Three census-based measures of self-reported health (number of chronic physical disabilities; activity limitation (a little; a lot); and chronic poor mental health) were linked to contemporaneous DLA records. The 2011 Census returns provided individual demographic, socio-economic, social and area-level characteristics. DLA uptake was modelled using logistic regression, stratified into 0-15 and 16-64 year old age groups. RESULTS: Overall, 118329 (8.4%) of this population received DLA. Poor health outcomes were the main determinants for uptake, which was higher amongst females, those non-married and those of lower socio-economic status: for example those with no qualifications compared against third level education (ORad = 1.80: 95%CI = 1.75-1.85); and those social renting compared against those in more expensive owner occupation (ORadj = 1.92: 1.83-2.02). Uptake was lower amongst Protestants than Catholics (ORadj = 0.75: 0.74-0.77) and amongst immigrants (ORadj = 0.36: 0.34-0.39) and slightly lower in rural communities. CONCLUSIONS: Poor health is the predominant determinant of disability benefits uptake but other social and socioeconomic factors have influence. These findings may assist in the reshaping of outreach programmes leading to better targeting of benefits, and therefore a more indirect influence on the derivation of area deprivation measures in the United Kingdom.

Social Capital and Mental Health Among Black and Minority Ethnic Groups in the UK.

Black and minority ethnic communities are at higher risk of mental health problems. We explore differences in mental health and the influence of social capital among ethnic minority groups in Great Britain. Cross-sectional linear and logistic regression analysis of data from Wave 6 (2014-2016) of the Understanding Society databases. In unadjusted models testing the likelihood of reporting psychological distress (i) comparing against a white (British) reference population Indian, Pakistani, Bangladeshi and mixed ethnic minority groups recorded excess levels of distress; and (ii) increasing levels of social capital recorded a strong protective effect (OR = 0.94: 95% CI 0.935, 0.946). In a subsequent series of gender-specific incremental logistic models-after adjustment for sociodemographic and socioeconomic factors Pakistani (males and females) and Indian females recorded higher likelihoods of psychological distress, and the further inclusion of social capital in these models did not materially alter these results. More research on the definition, measurement and distribution of social capital as applies to ethnic minority groups in Great Britain, and how it influences mental wellbeing is needed.

Rates and predictors of anti-depressant prescribing in Northern Ireland 2011-2015: a data linkage study using the Administrative Data Research Centre (NI).

OBJECTIVES: Research indicates that anti-depressant prescribing is higher in Northern Ireland (NI) than in the rest of the UK, and that socio-economic and area-level factors may contribute to this. The current study provides comprehensive population-based estimates of the prevalence of anti-depressant prescription prescribing in NI from 2011 to 2015, and examined the associations between socio-demographic, socio-economic, self-reported health and area-level factors and anti-depressant prescription. METHODS: Data were derived from the 2011 NI Census (N = 1 588 355) and the Enhanced Prescribing Database. Data linkage techniques were utilised through the Administrative Data Research Centre in NI. Prevalence rates were calculated and binary logistic analysis assessed the associations between contextual factors and anti-depressant prescription. RESULTS: From 2011 to 2015, the percentages of the population in NI aged 16 or more receiving anti-depressant prescriptions were 12.3%, 12.9%, 13.4%, 13.9% and 14.3%, respectively, and over the 5-year period was 24.3%. The strongest predictors of anti-depressant prescription in the multivariate model specified were 'very bad' (OR = 4.02) or 'Bad' general health (OR = 3.98), and self-reported mental health problems (OR = 3.57). Other significant predictors included social renting (OR = 1.67) and unemployment (OR = 1.25). Protective factors included Catholic religious beliefs, other faith/philosophic beliefs and no faith/philosophic beliefs in comparison to reporting Protestant/other Christian religious beliefs (ORs = 0.78-0.91). CONCLUSION: The prevalence of anti-depressant prescription in NI appears to be higher than the prevalence of depressive disorders, although this may not necessarily be attributable to over-prescribing as anti-depressants are also prescribed for conditions other than depression. Anti-depressant prescription was linked to several factors that represent socio-economic disadvantage.

Patterns of long-term conditions in older age and subsequent mortality: a national study of inequalities in health.

BACKGROUND: Multiple long-term health conditions in older people are associated with increased mortality. The study aims to identify patterns of long-term health in a national ageing population using a census-based self-reported indicator of long-term health conditions. We assessed associations with subsequent mortality and socio-economic and demographic risk factors. METHODS: Using linked administrative data from the Northern Ireland Mortality Study, we assessed the presence of latent classes of morbidity in self-reported data on 11 long-term health conditions in a population aged 65 or more (N = 244 349). These classes were associated with demographic and socio-economic predictors using multi-nomial logistic regression. In a 3.75-year follow-up, all-cause and cause-specific mortality were regressed on morbidity patterns. RESULTS: Four latent classes of long-term ill-health conditions were derived, and labelled: 'low impairment'; 'pain/mobility'; 'cognitive/mental'; 'sensory impairment'. Groupings reflecting higher levels of long-term ill-health were associated with class-specific increases in all-cause and cause-specific mortality. Strongest effects were found for the 'cognitive/mental' group, which predicted all-cause mortality [hazard ratio (HR) = 2.96: 95% confidence interval (CI) = 2.83, 3.10) as well as some cause-specific mortality (i.e. dementia-related death: HR = 10.78: 95% CI = 9.39, 12.15). Class membership was predicted by a range of socio-demographic factors. Lower socio-economic status was associated with poorer health. CONCLUSION: Results indicate that long-term ill-health clusters in specific patterns, which are both predicted by socio-demographic factors and are themselves predictive of mortality in the elderly. The syndromic nature of long-term ill-health and functioning in ageing populations has implications for healthcare planning and public health policy in older populations.

Symptom profiles of late-life anxiety and depression: The influence of migration, religion and loneliness.

OBJECTIVE: To examine (1) clinically relevant anxiety with comorbid depression in an older population, and the presentation of subthreshold symptoms; (2) to assess anxiety and levels of comorbid depression associated with migration, religion, loneliness and long-term illness. METHODS: Analysis of Wave 1 of The Irish Longitudinal Study on Ageing (TILDA) (2009-2011). Latent class analysis (LCA) was used to define indicative diagnoses of anxiety and depression. We then assessed associations between sociodemographic and socioeconomic factors, past migration, religious practice, social network, loneliness and long-term illness. RESULTS: For those with clinically relevant anxiety, LCA derived three classes of self-reported depression: low, subthreshold and high. Approximately 19% were comorbid, and a further 37% reported subthreshold depression. Compared to those with low/no symptoms of depression, those classed as comorbid were more likely to be male, had lower education levels, had spent more time abroad, lower religious attendance, a limited social network, were lonelier and had a long-term life-limiting illness. Those with subthreshold levels of depression reported a more restricted social network and more moderate levels of loneliness. CONCLUSION: Findings support the actuality of comorbidity of both disorders. Consequently, government health strategy on detecting and managing social engagement, loneliness, and psychological disorders in older people may require a more granulated approach.

Improving mental health pathways and care for adolescents in transition to adult services (IMPACT): a retrospective case note review of social and clinical determinants of transition.

BACKGROUND: Poor transitions to adult care from child and adolescent mental health services may increase the risk of disengagement and long-term negative outcomes. However, studies of transitions in mental health care are commonly difficult to administer and little is known about the determinants of successful transition. The persistence of health inequalities related to access, care, and outcome is now well accepted including the inverse care law which suggests that those most in need of services may be the least likely to obtain them. We sought to examine the pathways and determinants of transition, including the role of social class. METHOD: A retrospective systematic examination of electronic records and case notes of young people eligible to transition to adult care over a 4-year period across five Health and Social Care NHS Trusts in Northern Ireland. RESULTS: We identified 373 service users eligible for transition. While a high proportion of eligible patients made the transition to adult services, very few received an optimal transition process and many dropped out of services or subsequently disengaged. Clinical factors, rather than social class, appear to be more influential in the transition pathway. However, those not in employment, education or training (NEET) were more likely (OR 3.04: 95% CI 1.34, 6.91) to have been referred to Adult Mental Health Services (AMHS), as were those with a risk assessment or diagnosis (OR 4.89: 2.45, 9.80 and OR 3.36: 1.78, 6.34), respectively. CONCLUSIONS: Despite the importance of a smoother transition to adult services, surprisingly, few patients experience this. There is a need for stronger standardised policies and guidelines to ensure optimal transitional care to AMHS. The barriers between different arms of psychiatry appear to persist. Joint working and shared arrangements between child and adolescent and adult mental health services should be fostered.

Does equality legislation reduce intergroup differences? Religious affiliation, socio-economic status and mortality in Scotland and Northern Ireland: A cohort study of 400,000 people.

Religion frequently indicates membership of socio-ethnic groups with distinct health behaviours and mortality risk. Determining the extent to which interactions between groups contribute to variation in mortality is often challenging. We compared socio-economic status (SES) and mortality rates of Protestants and Catholics in Scotland and Northern Ireland, regions in which interactions between groups are profoundly different. Crucially, strong equality legislation has been in place for much longer and Catholics form a larger minority in Northern Ireland. Drawing linked Census returns and mortality records of 404,703 people from the Scottish and Northern Ireland Longitudinal Studies, we used Poisson regression to compare religious groups, estimating mortality rates and incidence rate ratios. We fitted age-adjusted and fully adjusted (for education, housing tenure, car access and social class) models. Catholics had lower SES than Protestants in both countries; the differential was larger in Scotland for education, housing tenure and car access but not social class. In Scotland, Catholics had increased age-adjusted mortality risk relative to Protestants but variation among groups was attenuated following adjustment for SES. Those reporting no religious affiliation were at similar mortality risk to Protestants. In Northern Ireland, there was no mortality differential between Catholics and Protestants either before or after adjustment. Men reporting no religious affiliation were at increased mortality risk but this differential was not evident among women. In Scotland, Catholics remained at greater socio-economic disadvantage relative to Protestants than in Northern Ireland and were also at a mortality disadvantage. This may be due to a lack of explicit equality legislation that has decreased inequality by religion in Northern Ireland during recent decades.

Teenage motherhood: where you live is also important. A prospective cohort study of 14,000 women.

The United Kingdom has among the highest rates of teenage motherhood (TM) in Western Europe. The relationship to individual social and material disadvantage is well established but the influence of area of residence is unclear. We tested for additional TM risks in deprived areas or in cities. The Northern Ireland Longitudinal Study was used to identify 14,055 nulliparous females (15-18). TM risk was measured using multilevel logistic regression, adjusting for health status, religion, family structure, socio-economic status, rurality and employment-based area deprivation. Most variation in TM was driven by individual, household and socioeconomic factors with the greatest proportion of mothers in low value or social rented accommodation. Living in an area with fewer employment opportunities was associated with elevated TM risk (most vs. least deprived, ORadj =1.98 [1.49, 2.63]), as was urban dwelling (urban vs. intermediate, ORadj =1.42 [1.13, 1.78]). We conclude that area of residence is a significant independent risk factor for TM. Interventions should be targeted towards the most deprived and urban areas and to those in the lowest value housing.

Religion and the risk of suicide: longitudinal study of over 1 million people.

BACKGROUND: Durkheim's seminal historical study demonstrated that religious affiliation reduces suicide risk, but it is unclear whether this protective effect persists in modern, more secular societies. AIMS: To examine suicide risk according to Christian religious affiliation and by inference to examine underlying mechanisms for suicide risk. If church attendance is important, risk should be lowest for Roman Catholics and highest for those with no religion; if religiosity is important, then 'conservative' Christians should fare best. METHOD: A 9-year study followed 1 106 104 people aged 16-74 years at the 2001 UK census, using Cox proportional hazards models adjusted for census-based cohort attributes. RESULTS: In fully adjusted models analysing 1119 cases of suicide, Roman Catholics, Protestants and those professing no religion recorded similar risks. The risk associated with conservative Christians was lower than that for Catholics (HR = 0.71, 95% CI 0.52-0.97). CONCLUSIONS: The relationship between religious affiliation and suicide established by Durkheim may not pertain in societies where suicide rates are highest at younger ages. Risks are similar for those with and without a religious affiliation, and Catholics (who traditionally are characterised by higher levels of church attendance) do not demonstrate lower risk of suicide. However, religious affiliation is a poor measure of religiosity, except for a small group of conservative Christians, although their lower risk of suicide may be attributable to factors such as lower risk behaviour and alcohol consumption.

Using record linkage to monitor equity and variation in screening programmes.

BACKGROUND: Ecological or survey based methods to investigate screening uptake rates are fraught with many limitations which can be circumvented by record linkage between Census and health services datasets using variations in breast screening attendance as an exemplar. The aim of this current study is to identify the demographic, socio-economic factors associated with uptake of breast screening. METHODS: Record linkage study: combining 2001 Census data within the Northern Ireland Longitudinal Study (NILS) with data relating to validated breast screening histories from the National Breast Screening System. A cohort was identified of 37,059 women aged 48-64 at the Census who were invited for routine breast screening in the three years following the Census. All cohort attributes were as recorded on the Census form. RESULTS: The record linkage methodology enabled the records of almost 40,000 of those invited for screening to be analysed at an individual level, exceeding the largest published survey by a factor of ten. This produced a more robust analysis and demonstrated (in fully adjusted models) the lower uptake amongst non-married women and those in the lowest social class (OR 0.74; 95%CI 0.66, 0.82), factors that had not been reported earlier in the UK. In addition, with the availability of both individual and area information it was possible to show that the much lower screening uptake in urban areas is not due to differences in population composition suggesting unrecognised organisational problems. CONCLUSIONS: Linkage of screening data to Census-based longitudinal studies is an efficient and powerful way to increase the evidence base on sources of variation in screening uptake within the UK.

Trends in suicide among migrants in England and Wales 1979-2003.

OBJECTIVE: Trends in suicide death rates among migrants to England and Wales 1979-2003 were examined. METHODS: Age-standardised rates derived for eight country of birth groups. RESULTS: For men born in Jamaica, suicide death rates increased in 1999-2003. There were declines in rates for men and women from India and from Scotland, men from East Africa and Northern Ireland and women from the Republic of Ireland. For both men and women born in Scotland or the Irish Republic, despite declines for some, rates remained higher than for England and Wales born. Rates among men from Pakistan were consistently lower than men born in England and Wales. CONCLUSION: These analyses indicate declining trends for most migrant groups and for England and Wales-born women, but adverse trends in death rates for some country of birth groups.

Mortality from circulatory diseases by specific country of birth across six European countries: test of concept.

BACKGROUND: Important differences in cardiovascular disease (CVD) mortality by country of birth have been shown within European countries. We now focus on CVD mortality by specific country of birth across European countries. METHODS: For Denmark, England and Wales, France, The Netherlands, Scotland and Sweden mortality information on circulatory disease, and the subcategories of ischaemic heart disease, and cerebrovascular disease, was analysed by country of birth. Information on population was obtained from census data or population registers. Directly age-standardized rates per 100 000 were estimated by sex for each country of birth group using the WHO World Standard population 2000-25 structure. For differences in the results, at least one of the two 95% confidence intervals did not overlap. RESULTS: Circulatory mortality was similar across countries for men born in India (355.7 in England and Wales, 372.8 in Scotland and 244.5 in Sweden). For other country of birth groups-China, Pakistan, Poland, Turkey and Yugoslavia-there were substantial between-country differences. For example, men born in Poland had a rate of 630.0 in Denmark and 499.3 in England and Wales and 153.5 in France; and men born in Turkey had a rate of 439.4 in Denmark and 231.4 in The Netherlands. A similar pattern was seen in women, e.g. Poland born women had a rate of 264.9 in Denmark, 126.4 in England and Wales and 54.4 in France. The patterns were similar for ischaemic heart disease mortality and cerebrovascular disease mortality. CONCLUSION: Cross-country comparisons are feasible and the resulting findings are interesting. They merit public health consideration.

Migrant mortality from diabetes mellitus across Europe: the importance of socio-economic change.

The first objective of this study was to determine and quantify variations in diabetes mortality by migrant status in different European countries. The second objective was to investigate the hypothesis that diabetes mortality is higher in migrant groups for whom the country of residence (COR) is more affluent than the country of birth (COB). We obtained mortality data from 7 European countries. To assess migrant diabetes mortality, we used direct standardization and Poisson regression. First, migrant mortality was estimated for each country separately. Then, we merged the data from all mortality registers. Subsequently, to examine the second hypothesis, we introduced gross domestic product (GDP) per capita of COB in the models, as an indicator of socio-economic circumstances. The overall pattern shows higher diabetes mortality in migrant populations compared to local-born populations. Mortality rate ratios (MRRs) were highest in migrants originating from either the Caribbean or South Asia. MRRs for the migrant population as a whole were 1.9 (95% CI 1.8-2.0) and 2.2 (95% CI 2.1-2.3) for men and women respectively. We furthermore found a consistently inverse association between GDP of COB and diabetes mortality. Most migrant groups have higher diabetes mortality rates than the local-born populations. Mortality rates are particularly high in migrants from North Africa, the Caribbean, South Asia or low-GDP countries. The inverse association between GDP of COB and diabetes mortality suggests that socio-economic change may be one of the key aetiological factors.

The effect of population movement on the spatial distribution of socio-economic and health status: analysis using the Northern Ireland mortality study.

This paper examines the impact of population movement on the spatial distribution of socio-economic and health status in Northern Ireland. Five percent of the population cohort changed decile of deprivation between 2000 and 2001, resulting in a net gain in more affluent deciles and a net loss in more deprived areas. In addition, there was a net gain of relatively more affluent people in the more affluent deciles and a net loss of such people from more deprived deciles. However, this selective mobility had a minimal impact on the spatial distribution of health. More pronounced effects may be observed in longer periods of follow-up.

Area of residence and alcohol-related mortality risk: a five-year follow-up study.

AIMS: To examine differences in alcohol-related mortality risk between areas, while adjusting for the characteristics of the individuals living within these areas. DESIGN: A 5-year longitudinal study of individual and area characteristics of those dying and not dying from alcohol-related deaths. SETTING: The Northern Ireland Mortality study. PARTICIPANTS: A total of 720,627 people aged 25-74, enumerated in the Northern Ireland 2001 Census, not living in communal establishments. MEASUREMENTS: Five hundred and seventy-eight alcohol-related deaths. FINDINGS: There was an increased risk of alcohol-related mortality among disadvantaged individuals, and divorced, widowed and separated males. The risk of an alcohol-related death was significantly higher in deprived areas for both males [hazard ratio (HR) 3.70; 95% confidence interval (CI) 2.65, 5.18] and females (HR 2.67 (95% CI 1.72, 4.15); however, once adjustment was made for the characteristics of the individuals living within areas, the excess risk for more deprived areas disappeared. Both males and females in rural areas had a reduced risk of an alcohol-related death compared to their counterparts in urban areas; these differences remained after adjustment for the composition of the people within these areas. CONCLUSIONS: Alcohol-related mortality is higher in more deprived, compared to more affluent areas; however, this appears to be due to characteristics of individuals within deprived areas, rather than to some independent effect of area deprivation per se. Risk of alcohol-related mortality is lower in rural than urban areas, but the cause is unknown.

Dissonances in self-reported health and mortality across denominational groups in Northern Ireland.

Measures of self-reported health status are increasingly used in research and health policy. However, the inherent subjectivity of the responses gives rise to lingering concerns about their utility, especially across national and cultural boundaries. In this study we use religious denomination as a proxy for Scottish ancestry within Northern Ireland and demonstrate significant differences in levels of self-reported ill-health that are not fully reflected in mortality risks. These findings mirror the differences between Scotland and Northern Ireland previously shown in ecological studies and provide more definitive evidence that even within the United Kingdom factors other than morbidity levels influence the perception and reporting of health status. Possible explanations for the dissonance between morbidity and mortality levels are discussed and the reasons for a preference for socio-economic rather than cultural factors are described.